Archive | May 2014

So I have some exciting news! On Mother’s Day 2014, I found out I’m expecting my fourth child.

I’d love for you to join me on my pregnancy journey. I know you’re going to learn lots along the way.

For those who don’t know me, I’m a Birth Doula and Prenatal Teacher in the Surrey, Langley area of British Columbia, Canada (near Vancouver). I had my first two kids in hospital and the third one was the most fun birth yet – it was a homebirth. So for this one, I am of course, planning another homebirth. I’ve moved neighbourhoods since my last one, so I have to find another midwife. (You can read more about my first birth, and see the slideshow of my home birth at Birth Stories

I thought today I’d provide you with some information about midwives in BC.

1. Midwives are covered by MSP in British Columbia

That’s right! I’m always shocked and horrified that people don’t know their options when it comes to midwives. They think they have to pay out-of-pocket. They think that they have to have a doctor.

Here are the facts in BC : there are three kinds of maternity care providers and they are all covered by MSP, which means it is free for you – Family Physicians who do maternity care, Midwives, and OBs.

2. If you have a midwife, you don’t need to have a doctor for your pregnancy

In some countries, midwives are like nurses. But in BC, midwives practice independently so if you have a midwife, you do not have to also see a doctor for your pregnancy.

If you have a high risk pregnancy, OBs are a great option for you. In fact, family physicians and midwives will refer or consult with OBs if any high risk situation occurs. But, research shows, if you have a low-risk pregnancy, midwives are a great option for you. Midwives specialize in low-risk birth, so they have the kind of skills needed to help you have a natural birth, and yet are trained to deal with situations where more medical help is needed. OBs, specialize in high risk birth and are not skilled in helping moms have a natural birth. They resort to medical intervention much sooner than midwives would. As such, comparing all low-risk pregnancies, OBs have much higher cesarean, induction and instrumental delivery rate.

3. Midwives have much longer visits

Midwives are paid more than Family Physicians for each pregnancy mom they have, but less than OBs. This is because midwives spend 45 mins with each client at prenatal appointments as opposed to the 5 – 10 mins doctors spend. This is to build a relationship and cover more comprehensive information with women which includes, nutrition, wellness, informed decision making, choices in birth and so on.

4. Midwives are responsible for you and your baby up to 6 weeks postpartum

Midwives provide continuity of care through the whole pregnancy, birth and up to 6 weeks postpartum.

5. To find a complete list of midwives in your area of BC

6. Register ASAP

I’d suggest calling several or all the midwifery offices in your area and registering as soon as you can. Midwives fill up fast. It’s ideal if you can register as soon as you find out you’re pregnant. If you would like to close the best midwife for you, register with a few so you can have a chance to interview them and decide which ones you like best.

If you’re further along and you have decided to switch from doctor care to midwifery care, do not despair. Although it can be hard to find a midwifery office with space, it is possible. I have had many doula clients decide mere weeks before they gave birth that they wanted to switch to midwifery care. They called a couple of midwives and found them to be full but after my encouragement, they called ALL the midwives in their area until they managed to find midwives with space. Go to one of the websites above and call ALL the midwives in your area. Don’t just give up after one or two.

For the Crunchy Granola Mammas :

Now having said that, if you are of the crunchy granola sort, like me, you wouldn’t just want to stop at choosing a midwife attended birth. You would want to carefully select a midwife who aligns with the kind of birth preferences you want. All registered midwives in BC practice within a range of guidelines. But there is a wide range of what some midwives are comfortable with. There has been some criticism that some midwives practice too much like doctors, jumping to medical intervention too soon before trying natural methods. They have been termed “medwives”.

There are also a few midwives who have chosen not to be registered with the college of midwives, and do not follow their guidelines. This is an interesting point, because before 1998, all the midwives were not registered with MSP. MSP only started including midwives in 1998. So a few of those midwives did not register because they felt registering would inhibit their ability to practice in the way they had previously been practicing. So the college of midwives now refers to them as “Lay Birth Attendants” instead of midwives. Why would they not want to be registered? Well, before the college was established, the midwives were trained in and regularly attended breech or twin births. Remember, in Europe, these are seen as variations of normal birth and not high risk situations. If the birth attendant is trained in how to properly attend breech or twin births, the risks are minimal. But in North America, breech and twin births have been considered too risky and are reason for automatic cesarean. Over time, the doctors and midwives skilled in such births have retired and the new ones left are not skilled in such births, which really does make it risky.

So if you would like to really increase your chances of having a gentle, natural birth or even a homebirth, but you don’t want to go with a birth attendant who is not covered by MSP, what do you do?

Like all advice about choosing your caregiver, you need to interview them and choose the one who matches your expectations. Don’t assume that just because they are midwives that they will all be totally crunchy granola. Here’s an example of what I mean by that : some women really want their pregnancies to be rushed along towards the end. They don’t mind having a stretch and sweep of the membranes in hopes starting labour earlier. But some women would be insulted at the mere question of whether they want a sweep. They want labour to start on its own. Some midwives routinely offer sweeps at 39 weeks and some don’t. So figure out what you want and find the care provider who matches.

Here are some questions you can ask :

1. Are you comfortable not doing any vaginal checks for dilation?

2. Are you comfortable attending a homebirth?

3. Have you attended water births before?

4. If the water breaks before contractions start, are you comfortable waiting without inducing as long as their are no internal checks and signs of infection?

5. Are you comfortable if a mom declines all or most prenatal screening tests?

6. Are you comfortable waiting a long time before cutting the cord, if at all?

7. Are you comfortable with a natural third stage (placenta stage)?

Hope that helps you in choosing the best care provider for you and your pregnancy!

BTW, if you would like to know more about any of these questions and why they might be important, leave a comment below, send me and email at kaurina @ prenatal journey. ca or call me at 604 809 3288.